Bill Would Help Medicare Patients Access Care Faster

Seniors with Medicare Advantage plans might see preapproval times for medical services speed up, thanks to a bipartisan bill recently reintroduced in Congress.

The Improving Seniors’ Timely Access to Care Act of 2024 pledges to reduce paperwork for and otherwise speed up the prior authorization process. The goal is to get seniors into medical services faster.

As things stand today, health care providers treating patients with Medicare Advantage plans often must wait for prior approval from insurance companies before moving ahead with services. That means patient care is often delayed and sometimes denied.

Medicare Advantage plans, one of two main types of Medicare coverage, are offered by health insurance companies that contract with the federal government. Traditional Medicare coverage, on the other hand, is offered directly by the government.

Prior authorization is a technique health insurers use to try to curb unnecessary care and improper payments. It requires health care providers to get preapproval from insurers before they move forward with specific medical services. Otherwise, insurers may not cover those services.

But the bill’s cosponsors say the inefficiency of the Medicare Advantage prior authorization system causes too many delays. Those cosponsors are Sens. Sherrod Brown (D-Ohio), Roger Marshall (R-Kan.), Kyrsten Sinema (I-Ariz.) and John Thune (R-S.D.).

Brown’s office says the bill would establish an electronic prior authorization process for Medicare Advantage plans that is standardized and more transparent.

It also would require the U.S. Department of Health and Human Services and other agencies to report to Congress on this and other ways to improve the electronic prior authorization process.

Under today’s rules, Medicare Advantage patients often have to wait seven days for a prior authorization to be approved, according to a Newsweek report. Even when the process is expedited, it still can take 72 hours.

Traditional Medicare, also known as Original Medicare, seldom requires prior authorization, however.

What happens next?

The American Hospital Association — which represents nearly 5,000 hospitals and other health care organizations — officially supports the Improving Seniors’ Timely Access to Care Act. Theoretically, that should bode well for the legislation.

But Congress has been here before. The bill was introduced in each of the past five years, and none of those versions went the distance. The 2021 version of the bill was the only one to be passed by a full chamber of Congress (the House), but it was never even read by the other chamber (the Senate).

If you want to know more about the bill, check it out online. And if you have strong feelings about the proposed legislation, contact your senators and offer your two cents.